Sustainability Through Diversified Revenue Streams · 2015. 10. 14. · SWOT Analysis • What are...
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Sustainability Through Diversified Revenue Streams R. Todd Welter, MS, CPC President RT Welter & Associates, Inc. www.RTWelter.com [email protected]
Transcript of Sustainability Through Diversified Revenue Streams · 2015. 10. 14. · SWOT Analysis • What are...
Sustainability Through Diversified Revenue Streams
R. Todd Welter, MS, CPC President
RT Welter & Associates, Inc. www.RTWelter.com [email protected]
Background & Experience
• 25+ years of health care management experience in public health and the private (for-profit) sectors
• Master’s degree in Management
• Consulting with Title X clinics on revenue cycle management, payer relationships and revenue stream
• Over ten years teaching experience in undergrad and graduate level - Health Care Management and Health Care Economics
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Healthcare
Increasing access …increases demand
Paradox
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MORE Insured Means (even) MORE DEMAND!
• 30 million more insured people
• Less Primary Care providers
– Train Wreck. Perfect Storm
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Today’s Changing Environment
More changes/opportunities in health care now than ever!
• >17% of our economy is changing
• >2 trillion dollars spent annually on health care
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Medicaid
• Medicaid Expansion through ACA – Optional for States to participate in expansion (feds will provide
funding for the first 3 years for states that do participate)
– 24 States planning to opt-in; 18 States with republican governors have refused
– Increases reimbursement for primary care
• Implementing Managed Care – Managed Care Organizations – Limited Benefit Plans – Primary Care Case Managers
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The HHS Triple Aim
1. Improving the health care experience
2. Improving the health of populations
3. Reducing per capita cost
• Enrollment of an identified population
• A commitment to universality
• The existence of an organization (an “integrator”) that accepts responsibility for all three Aims
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Business Basics Health care is a service business (like any service industry
business) • Clients/Customers:
– Who are they? – Where are they? – What do they want/what do the need (may not be the same
thing)?
• What is your product/service? • Fees (charges and pricing) • Provide the service and document the service • Obtain payment for the services
– Accounts Receivable (A/R) – Process and balance payments to receivables (Cash to
Services and Balance)
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The Health Care Revenue Cycle
Source: Health Data Management: “Revenue Cycle Management” June 2008
SWOT Analysis • What are the agency’s Strengths, Weaknesses, Opportunities,
and Threats?
• Value Proposition for the Agency
– What do we have to offer the Triple Aim?
– What are we delivering that is valuable to our local community?
– What makes us stand out?
– How do we help to reduce costs?
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What Does a Title X Agency Offer the Community?
• Comprehensive family planning services
• Teen clinics (adolescent care)
• Other direct services
• Convenient hours of operation
• Same day/next day appointments
• Types of providers (i.e., women’s health)
• Multi-lingual and culturally diverse
• On-site dispensing of birth control and other supplies
Are there more? Ask your customers!
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Title X Agency Role How do you fit in the local health care delivery
scene?
– Just like politics ….health care is local – Become part of the local health care community and
reach out to providers and other local stakeholders • Local medical colleagues (they need you, they do not
understand you) • Local hospitals • Payers:
– Who are the players? (ask colleagues as listed above) – Contact the provider services hotline to schedule a meeting with
whoever is responsible for network development (provider reps and contracting reps) – Find out what payers think your niche is
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Title X Agency Role (cont.) – Title X agency role in population health (what
family planning brings to the table)
– What should Title X agencies do to diversify revenue steams?
• Pharmacy Services
• Care Coordination for ACOs,
• Counseling & Education, etc.
• Partnering with other PCPs for well visits & screening
– THINK: Triple Aim
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Title X Agency Role (cont.)
There is a primary care shortage – The crisis is not only a shortage of primary care
physicians
– It includes basic health care services
– This could mean growth and more patients for Title X agencies
“Retail Medicine” (basic care, screening) is growing (The real experts: Title X clinics have been doing the same thing for 40+ years)
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Fee for Service Performance Based FFS Shared Savings Risk Sharing Full Capitation
Incr
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Le
vel o
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isk
Title X Role in Health Insurance • Many types of payers/products/features
– Even within a community
The PPACA requires the Health Insurance Marketplaces to have multiple delivery models:
“Actuarial Value”
The ACA specifies that beginning in January 2014 insurance newly sold to individuals and small businesses through a “Marketplace” or otherwise be at one of these actuarial value (AV) levels
–Platinum 90% –Gold 80% –Silver 70% –Bronze 60%
AV = Payer/Patient cost share
Title X Role in Health Insurance (cont.)
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Title X Role in Health Insurance (cont.)
Marketplaces: What is happening in your state?
– Required by the Affordable Care Act
– States may participate in either state or federal marketplaces
– Participating health plans must contract with “Essential Community Providers”
– Title X agencies are included in the CMS list of “Essential Community Providers”
– Are there opportunities for your agency to provide services to meet the needs of a particular population or community?
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Culture Change
• Seeking diverse revenue streams
• Looking at cash flow/cash control – an uncomfortable but important topic
• Charge capture. You must add value to what you do (monetary value)
• Team building opportunity for service sites and a call for leadership by grantees
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Questions?
RT Welter & Associates, Inc.
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303-534-0388
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